Cryosurgery as a means to improve surgical treatment of patients with multiple unresectable liver metastases

Background: The aim of the study was to evaluate the results of cryosurgery in patients with multiple (five or more), heavily pretreated, unresectable liver metastases. Materials and Methods: Nineteen patients with multiple u nresectable liver metastases were entered into a prospective nonrandomized trial. The liver tumours were treated during surgery under ultrasound guida nce. All the patients were followed-up to assess complications, treatment r esponse and sites of recurrence. Results: 140 metastases were identified in 19 patients (mean, 7; range, 5-25) and 13 patients had a synchronous liver resection. Cryosurgery was used to treat 90 metastases (mean diameter, 30 mm; range, 10-135). There were no treatment-related deaths and the over all rate of complications was 21%. During a mean follow-up of 28 months (range , 5-60), tumours recurred at the site of cryosurgery in two patients (10%), in the remaining liver in nine patients (47%) and elsewhere in five patien ts (26%). Three patients had no evidence of disease 48, 50 and 60 months af ter liver cryosurgery, respectively. Conclusion: Cryosurgery may be effecti ve in the treatment of patients with multiple unresectable liver metastases and should be investigated in multimodality treatment programmes.